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General Peds Boards > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Primary ciliary dyskinesia genetics

A

Homozygous mutation in DNAH11

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2
Q

Primary ciliary dyskinesia symptoms

A
  • History of neonatal respiratory issues
  • Chronic daily nasal drainage
  • Chronic wet cough that is worse in the morning
  • Chronic otitis media
  • Recurrent bronchitis/pneumonia
  • Bronchiectasis
  • Male infertility
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3
Q

Situs inversis totalis, chronic sinusitis, bronchiectasis

A

Kartagener syndrome

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4
Q

Infant or toddler with nonproductive cough, expiratory wheeze, and decreased breath sounds

A

Foreign body aspiration

  • Toddlers aspirate food (hot dogs, popcorn)
  • Older kids aspirate objects
  • Cough of SUDDEN ONSET
  • Often in the right mainstem bronchus
  • Diagnose: inspiratory/expiratory films, airway fluoroscopy, bronch to retrieve the object
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5
Q

Symptoms/diagnosis of swallowing dysfunction

A
  • Cough/wheezing after feeds
  • Confirm with barium swallow study with video fluorscopy
  • Tx: thickened feeds, feeding therapy, maybe NG
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6
Q

Recurrent wheezing in an infant that increases with feeding and neck flexion

A

Vascular ring or other things compressing the trachea

- Can also have stridor and/or dyspnea during feeding

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7
Q

Hemoptysis, iron deficiency anemia, and diffuse pulmonary infiltrates

A

Hemosiderosis

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8
Q

Treatment for congenital malformations of the lung

A

Surgical removal

- Present with recurrent respiratory symptoms or can be incidental finding on CXR

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9
Q

Causes of clubbing

A
  • Cyanotic heart disease
  • Chronic lung disease
  • Cirrhosis of the liver

Technical term: hypertrophic pulmonary osteoarthropathy

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10
Q

Lab definitions of respiratory failure

A
  • PaCO2 > 50

- PaO2 < 50

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11
Q

CF sweat test diagnostic values

A

< 30 is negative
30-60 is intermediate
> 60 is positive

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12
Q

Nasal polyps, rectal prolapse, meconium ileus –> what test do these people need?

A

Sweat test to rule out CF

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13
Q

Pleural fluid characteristics associated with empyema

A
  • Purulent fluid
  • Cell count: > 10,000 WBC
  • pH < 7.1
  • LDH > 1000
  • Glucose < 50% serum glucose
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14
Q

Definition of pulsus paradoxus

A

Difference in BP of > 20 mmHg between inspiration and expiration –> this suggests pulmonary or cardiac issues

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15
Q

Signs of chronic hypoxemia

A
  • Increased hematocrit: headaches, joint pain, clots (PEs), hemoptysis
  • Increased risk of bleeding due to shortened platelet life
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16
Q

Symptoms of hypercarbia vs hypoxia

A
  • Hypoxia: cyanosis, depressed sensorium

- Hypercarbia: flushing, agitation, headaches –> cerebral vasodilation

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17
Q

Indications for home apnea monitor

A
  • Severe BRUE (requiring CPR)
  • Symptomatic apnea of prematurity
  • Central hypoventilation syndrome
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18
Q

Symptoms of hypoxia

A

Cyanosis, depressed sensorium

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19
Q

Symptoms of hypercarbia

A

Flushing, agitation, headaches - due to elevated CO2 leading to cerebral vasodilation

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20
Q

Symptoms of chronic hypoxemia

A
  • Elevated hematocrit –> headaches, joint pain, clots, hemoptysis
  • Respiratory drive is driven by hypoxemia (rather than hypercapnia) so give patients the lowest amount of oxygen they need otherwise could lead to respiratory arrest
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21
Q

What does pulse ox measure

A
  • Differential light abosrption of oxyhemoglobin and deoxyhemoglobin so estimates the saturation of hemoglobin with oxygen
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22
Q

Carbon monoxide poisoning and pulse ox

A
  • Falsely elevated pulse ox reading due to carboxyhemogobin absorbing light in the same wavelength as oxyhemoglobin
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23
Q

Definition of cyanosis

A
  • Central blueish discoloration of the skin due to poorly oxygenated blood
  • Can be seen at 5 g/dL of desaturated hemoglobin so more readily seen at higher hemoglobin leels
24
Q

Cause and symptoms of methemoglobinemia

A
  • Due to iron in the hemoglobin molecule being oxidized ferric state so can’t unload oxygen –> cyanosis
  • Fatigue, dizziness, nausea, arrhythmias, seizures, altered mental status
  • Pulse ox will be around 85% but this is not a reliable/true reading
  • Treat with methylene blue
25
Q

Loud barking cough that can be produced on command and disappears with sleep

A

Psychogenic cough

26
Q

Initial workup for chronic cough

A

Sweat chloride, TB skin test, CXR, spirometry if > 6 years old

27
Q

Diagnostic cutoff for sweat chloride test

A

> 60 mEq — this is the gold standard for diagnosis of CF

28
Q

Genes and inheritence of CF

A
  • Autosomal recessive
  • CFTR gene
  • Odds of a healthy sibling of someone with CF being a carrier is 2/3
  • General caucasian carrier rate is 1/25
29
Q

Newborn screening limitations/follow up for CF

A
  • Newborn screen is only 95% sensitive
  • Only 1/20 infants with an abnormal NBS for CF have CF
  • Need a sweat test
30
Q

Main GI symptoms of CF

A
  • Newborn: meconium ileus (polyhydramnios can be presenting sign), meconium peritonitis (pseudocyst on xray), unconjugated hyperbilirubinemia
  • Steatorrhea, fat soluble vitamin deficiency (especially vitamin E)
31
Q

Bacteria and treatment involved in CF exacerbations

A
  • Staph aureus, H. flu, psuedomonas, Burkholderia cepacia (associated with worsening lung function)
  • Tx with aminoglycoside and penicillin (piperacillin)
32
Q

Newborn with respiratory distress after C-section and oxygen sats lower in lower extremities than in upper extremities

A

PPHN - can also have a precordial lift or RV heave

33
Q

Signs of cor pulmonale

A
  • Lower body edema, hepatomegaly, gallop, clubbing

- Often caused by pulmonary hypertension and dis due to RV dysfunction

34
Q

Chronic sinusitis, bronchiectasis, male infertility

A

Primary ciliary dyskinesia - autosomal recessive

  • Only way to diagnose is with a biopsy
  • Associated with situs inversus and Kartagener syndrome
35
Q

Pleural fluid with triglycerides > 110, elevated lymphocyte count, protein greater than 3

A

Chylothorax

36
Q

Plueral fluid with LDH at least 2/3 the serum LDH, protein is 3 or greater, pH < 7.3

A

Exudative - seen with inflammation - pneumonia, cancer, trauma, inflammatory disease

37
Q

Pleural fluid with LDH < 2/3 serum concentration, protein < 3, pH > 7.45

A

Transudative - congestive heart failure

38
Q

Patient diagnosed with pneumonia initially improves and then worsens again

A

Think empyema – chest tube, drainage, IV antibiotics

39
Q

Patient with tachypnea, tachycardia, unilateral decreased breath sounds
- Can also be associated with marijuana smoking

A

Pneumothorax

  • Treat with observation and oxygen if small
  • If needed can do needle decompression and/or chest tube if tension
40
Q

Causes of bronchiectasis

A
  • PCD
  • CF
  • Immunodeficiency
  • Lobar pneumonia
  • Aspergillosis, measles, pertussis, TB
  • Extrinsic compression
41
Q

Symptoms and diagnosis for bronchiectasis

A
  • Repeated lower respiratory tract infections, coughing that is worse with change in position
  • Dx with CT of the chest
42
Q

Most common causes of hemoptysis in kids

A
  • Infection (pneumonia, TB)
  • CF (bronchiectasis)
  • Foreign body aspiration
  • Hemosiderosis
43
Q

Workup for hemoptysis

A
  • pH of the emesis (acidic is stomach, alkaline is lungs)
  • CBC, coags
  • CXR and direct visualization of the airway
44
Q

MCC pneumonia in infants (3 weeks through 12 months)

A
  • Chlamydia transmitted during delivery (afebrile, interstitial infiltrates on CXR)
  • RSV (late fall, wheezing)
  • Parainfluenza (fall through spring)
  • Pertussis (paroxysmal cough, no fever)
45
Q

MCC pneumonia in pre school (1-4 years)

A
  • Viral (RSV, parainfluenza, influenza, rhinovirus, HMPV)

- S. pneumonia (productive cough, can have abdominal pain and vomiting as well, fevers)

46
Q

MCC pneumonia in school ages

A
  • Mycoplasma pneumonia (low grade fever, CXR with diffuse non focal infiltrates)
  • Chlamydophilia
  • S. pneumonia (can have empyemas in this age)
  • Mycobacterium TB (with risk factors)
  • S. aureus (following influenza)
47
Q

3 most common complications of pneumonia

A
  • Effusions/empyema
  • Lung abscess
  • Necrotizing pneumonia (tx with vanc/clinda)
48
Q

Side effects of albuterol

A

Tremors, tachycardia, hypokalemia

49
Q

Steroids effects in asthma

A

Interferes with late response and airway wall edema/inflammation but not early response (bronchoconstriction due to IgE mediation needs beta agonsists)

50
Q

Xray finding for foreign body aspiration

A

Unilateral hyperlucency on expiration film

51
Q

Long term complications of foreign body aspiration

A

Chronic cough, bronchiectasis, lung asbcess, recurrent pneumonia, unnecessary medications

52
Q

Cause and implications of hydrocarbon pneumonitis

A
  • In household products
  • Can lead to respiratory distress and secondary infections
  • Long term risk for lung fibrosis
53
Q

Hemoptysis, iron deficiency anemia, and diffuse pulmonary infiltrates

A

Hemosiderosis

  • Sx can include fatigue, cough, wheezing, dyspnea, hypoxemia and respiratory failure
54
Q

Differential diagnosis of recurrent pneumonia

A
  • Aspiration - TE fistula, laryngeal cleft
  • Foreign body
  • Anatomical malfromation (bronchogenic cyst, CCAM)
  • CF
  • PCD
55
Q

Manifestations of CF in infancy

A

Hypoalbuminemia, anemia, steatorrhea, recurrent pulmonary symptoms, hypokalemia alkalosis

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